CSP Flashcards
CSP - ROM
- Flexion - 60
- Extension - 60
- Lateral flexion - 45
- Rotation - 80
- TMJ - 35 - 50 mm opening
CSP - MYOTOMES
- Cervical flexion - C1, C2
- Cervical extension - C2, C3, XI
- Cervical lateral flexion - C3
- Shoulder elevation - C4, XI
- Deltoid - C5, C6 - axillary
- Brachioradialis - C5, C6 - radial
- Biceps - C5, C6 - musculocutaneous
- Triceps - C6, C7, C8, T1 - radial
- Wrist extensors - C6, C7, C8 - radial
- Wrist flexors - C6, C7 - median/ulnar
- Finger flexors - C7, C8, T1 - ulnar/median
- Interossei - C7, C8, T1 - ulnar
CSP - ORTHO TESTS - VBI
VBI - Vertebral basilar artery function test
CSP - ORTHO TESTS - INSTABILITY
- INSTABILITY - Lateral shear test
CSP - ORTHO TESTS - RADICULOPATHY
- RADICULOPATHY/NERVE TENSION - Cervical compression/distraction, Brachial plexus compression test
CSP - ORTHO TESTS - SPRAIN/STRAIN
- SPRAIN/STRAIN - Cervical distraction
CSP - JOINT TYPE
- Gliding - zygapophyseal joints
- Pivot - atlantoaxial joint
- Fibrocartilaginous - intervertebral joints
- Hinge and gliding - TMJ
CSP - ARTICULAR SURFACES
- Atlanto-occipital joint - convex (occipital condyles of occiput) on concave (superior articular facets of atlas)
- Atlantoaxial - concave (articular facet of dens on atlas) on convex (anterior facet of dens on axis)
- Zygapophyseal - facets are orientated at 45
- Intervertebral discs - horizontal plane
- TMJ - convex (mandibular condyle on disc) on concave (mandibular fossa of temporal bone)
CSP - MAIN MUSCLE ACTIONS - FLEXION
- FLEXION - sternocleidomastoid, longus cervicis, longus capitis, rectus capitis anterior
CSP - MAIN MUSCLE ACTIONS - EXTENSION
- EXTENSION - trapezius, splenius cervicis & capitis, longis capitis, levator scapulae, suboccipitals
CSP - MAIN MUSCLE ACTIONS - LATERAL FLEXION
- LATERAL FLEXION - scalenes, levator scapula, longissimus capitis, splenius capitis & cervicis, rectus capitis lateralis
CSP - MAIN MUSCLE ACTIONS - ROTATION
- ROTATION - SCM, longus capitis & coli, rotatores, splenius, suboccipitals
CSP - RESTING POSITION
Csp: slight extension
TMJ: mouth closed with teeth not in contact
CSP - CLOSED PACKED POSITION
Csp: full extension
TMJ: teeth clenched
CSP - NORMAL END FEEL
Tissue stretch (for all actions)
CSP - ABNORMAL END FEEL
Early myospasm - muscle/ligament tear
Late myospasm - instability
Empty - ligament rupture
Hard - bone approximation (osteophyte)
CSP - COUPLED MOTIONS
C2-C7 vertebra
- Left lateral flexion coupled with left rotation
- Right lateral flexion coupled with right rotation
CSP - CONDITIONS - RADICULOPATHY
Hx - numbness, tingling, weakness or shooting electrical pain down the arm
S&S - decreased pain when supine; +ve neruological signs (decreased DTR, muscle weakness, decreased sensation) ; +ve cervical compression for arm pain
DDx - disc herniation, IVF encroachment, space occupying lesion, TOS
CSP - CONDITIONS - OSTEOARTHRITIS
Hx - patient > 50; gradual onset; crepitus; morning stiffness; dull, achy pain
S&S - decreased pain with movement, worse at rest; limited AROM; confirm on x-ray (decreased joint space, osteophyte formation)
DDx - rheumatoid, IVF encroachment, ankylosing spindylitis
CSP - CONDITIONS - CERVICAL STRAIN
Hx - trauma or overuse; muscle pain/soreness
S&S - tender to palpation; AROM limited by pain; pain with muscle testing
DDx - cervical sprain, facet syndrome, meniscoid entrapment
CSP - CONDITIONS - CERVICAL JOINT DYSFUNCTION
Hx - insidious onset of local pain or discomfort
S&S - tender to palpation; limited joint play; local my-spasm; bone out of place
DDx - cervical sprain, facet syndrome, meniscoid entrapment
CSP - CONDITIONS - FACET SYNDROME
Hx - well localised unilateral pain that may radiate to shoulder, antalgic posture
S&S - increased pain with extension (loading facets); +ve cervical compression (local pain)
DDx - cervical sprain, menisci entrapment, torticollis
CSP - CONDITIONS - INSTABILITY
Hx - recurrent neck pain or clicking or clunking sensation
S&S - increased PROM with over pressure; x-ray flexion/extension views will show increased ROM
DDx - cervical sprain, OA
CSP - CONDITIONS - TMJ SYNDROME
Hx - jaw/facial pain worse with eating; locking or catching of the jaw; chronic headaches
S&S - decreased ROM due to pain, crepitus, tenderness to palpation
DDx - Bell’s palsy, trigeminal neuralgia, dental infection
CSP - CONDITIONS - VBI
Hx - atherosclerosis, hypertension, diabetes, smoking, ligamentous hypermobility
S&S - vertigo, dizziness, unsteadiness, visual changes, nystagmus; +ve VBI tests
DDx - stroke, TIA, positional vertigo
CSP - ORTHO TESTS - BIKELE’S SIGN
- Pt seated
- Shoulder abducted 90, elbow fully flexed
- Examiner instructs pt to extend elbow
CSP - ORTHO TESTS - BIKELE’S SIGN - POSITIVE TEST
Nerve root tension, brachial plexus neuritis, possibly meningitis
- Reproduction of radicular symptoms
CSP - ORTHO TESTS - BRACHIAL PLEXUS STRETCH TEST
- Pt seated or supine
- Examiner passively abducts straight arm and observes for signs of discomfort
- Then extends patients wrist
- Then laterally flexes head and extends wrist
CSP - ORTHO TESTS - BRACHIAL PLEXUS STRETCH TEST - POSITIVE TEST
Cervical radiculopathy (commonly C5)
- Reproduction of radicular symptoms with wrist extension
Myofascial contracture
- Local ‘stretch’ in arm or forearm
CSP - ORTHO TESTS - BRUDZINSKI’S SIGN
- Pt supine with legs straight
- Examiner flexes pt head and neck
CSP - ORTHO TESTS - BRUDZINSKI’S SIGN - POSITIVE TEST
Meningeal irritation/inflammation (meningitis)
- Involuntary hip and knee flexion
CSP - ORTHO TEST - SPURLING’S TEST
- Pt seated
- Examiner gently applies axial downward pressure on pt head in neutral position
- Examiner gently applies downward pressure with neck in extension
- Examiner gently applies downward pressure with head in extension and mild rotation to the affected side
- Examiner gently applies downward pressure with head in extension and mild rotation and side bent to the affected side
CSP - ORTHO TEST - SPURLING’S TEST - POSITIVE TEST
Increased pressure on nerve roots, IVF encroachment, DJD osteophyte, radiculopathy
- Increased peripheral pain
- Numbness
Local sprain/strain, joint damage, facet lock, menisci entrapment, cervical subluxation
- Local neck pain
CSP - ORTHO TEST - SPURLING’S TEST - SN & SP
SN: 11-100
SP: 74-100
CSP - ORTHO TEST - JACKSON’S COMPRESSION
- Pt seated
- Examiner gently applies axial downward pressure on pt head in neutral position
- Examiner gently applies downward pressure with neck in extension
- Examiner gently applies downward pressure with head in extension and mild rotation to the affected side
CSP - ORTHO TEST - JACKSON’S COMPRESSION - POSITIVE TEST
Increased pressure on nerve roots, IVF encroachment, DJD osteophyte, radiculopathy
- Increased peripheral pain
- Numbness
Local sprain/strain, joint damage, facet lock, menisci entrapment, cervical subluxation
- Local neck pain
CSP - ORTHO TEST - CERVICAL DISTRACTION
- Pt seated or supine
- Examiner stabilises under occiput and mandible
- Pt takes a deep breath in
- Examiner distracts pt head on exhalation
CSP - ORTHO TEST - CERVICAL DISTRACTION - POSITIVE TEST
Muscle, ligament or joint capsule damage
- Increased local pain
Decreased pressure on nerve roots, IVF encroachment, cervical radiculopathy
- Decreased peripheral pain/numbnessSN: 40-50SP: 80-100
Facet impingement, DJD
- Decreased local pain
CSP - ORTHO TEST - L’HERMITTE’S SIGN
- Pt seated or supine
- Pt head is passively flexed forward
- Examiner pay apply gently over pressure
CSP - ORTHO TEST - L’HERMITTE’S SIGN - POSITIVE TEST
Cervical radiculopathy
- Reproduction of radicular symptoms (sharp, shooting pain down spine or extremities)
CSP - ORTHO TEST - L’HERMITTE’S SIGN - SN & SP
SN: 3-89
SP: 41-97
CSP - ORTHO TEST - UPPER LIMB TENSION TEST
- Pt supine with shoulder in a depressed position (the depressed shoulder must remain for the entire test) and head laterally flexed away from the side being examined
- Examiner slowly moves the arm towards the end range
- MEDIAN NERVE: shoulder depressed and abducted 110, elbow, wrist and fingers extended, forearm supinated
- MEDIAN, MUSCULOCUTANEOUS, AXILLARY NERVE: shoulder depressed, externally rotated and abducted 10, elbow, wrist and fingers extended, forearm supinated
- RADIAL NERVE: shoulder depressed, externally rotated and abducted 10, elbow extended, forearm pronated, wrist flexed and deviated towards ulna, fingers flexed
- ULNAR NERVE: shoulder depressed, externally rotated and abducted 90 (pt hand should approximate ipsilateral ear), elbow flexed, forearm supinated, wrist extended and deviated towards the radius, fungers extended
CSP - ORTHO TEST - UPPER LIMB TRACTION TEST - POSITIVE TEST
Radiculopathy, peripheral nerve or fascial adhesions
- Arm pain
- Reproduction of neurologic symptoms
CSP - ORTHO TEST - UPPER LIMB TRACTION TEST - SN & SP
MEDIAN NERVE - SN: 97 SP: 22
RADIAL NERVE - SN: 72 SP: 33
CSP - CERVICAL STRAIN - DEFINITION
- Whiplash
- Causes Muscular + ligamentous structures of the cervical spine to be stretched beyond physiologic capacity
CSP - CERVICAL STRAIN - CAUSES
- Sudden hyperextension followed by hyper-flexion of the neck.
- Commonly from Rear end automobile collisions or Sports trauma
CSP - CERVICAL STRAIN - CLINICAL PRESENTATION
- Neck pain
- Persistent stiffness
- Trapezial/upper back pain
- Muscle spasm
- Headaches
- Limited ROM
- Must be aware to the discomfort it causes patients, however it usually has a benign course + minimal long term sequelae (an aftereffect of an injury)
- Our job to rule out morbid conditions, e.g. bony fracture from the large majority of cervical strains. Must be able to identify Ps with bone and neurologic pathology such as fractures, dislocations and spinal cord injuries that mimic the condition of a cervical strain
CSP - CERVICAL STRAIN - PROGNOSIS
- In at least 40% of people, there should be some resolution of symptoms by 6 weeks, and by 12 weeks, there should be complete resolution in at least 40% of people.
- Approximately 50% of people fully recover within 1 year of WAD.
CSP - CERVICAL DEGENERATION - DEFINITION
- Spontaneous degeneration of either disc or facet joints
CSP - CERVICAL DEGENERATION - CAUSES
- Accumulated wear and tear that occurs over a long period of time
CSP - CERVICAL DEGENERATION - AGE GROUPS AFFECTED
- Elderly
- By the age of 35, approximately 30% of people will show evidence of disc degeneration at one or more levels.
- By the age of 60, more than 90% of people will show evidence of some disc degeneration
CSP - CERVICAL DEGENERATION - RISK FACTORS
- Ageing
- Tough manual labour jobs
- Vigorous sports e.g. rugby
CSP - CERVICAL DEGENERATION - CLINICAL PRESENTATION
- Neck pain
- Stiffness
- Decreased ROM
- Numbness, tingling, or even weakness in the neck, arms and shoulders are additional symptoms due to nerves in the cervical area becoming irritated or pinched
- Pts should be asked to perform flexion, extension and rotational movements and report whether neck pain increases or decreases.
CSP - CERVICAL DEGENERATION - PROGNOSIS
- Symptoms worsen if left untreated
- Treatment centred around reliving pain, wont fully treat/relive symptoms
CSP - CERVICAL HERNIATION - DEFINITION
- When the outer part (annulus fibrosus) gets tears or splits, the gel (nucleus pulposus) can poke out. This is what it means for a disk to become herniated. (think jam donut)
CSP - CERVICAL HERNIATION - CAUSES
- Traumatic events, some spontaneous cases
- Most occur between C5 and T1
CSP - CERVICAL HERNIATION - AGE GROUPS AFFECTED
- More common in elderly due to wear and tear & less water in discs
CSP - CERVICAL HERNIATION - RISK FACTORS
- Age
- Lack of regular exercise
- Tobacco use
- Poor posture (i.e., incorrect lifting or twisting causing additional stress on the cervical spine)
- Injury
CSP - CERVICAL HERNIATION - CLINICAL PRESENTATION
- Frequent headaches
- Limited ROM
- Pain that originates around the paraspinal muscles radiates down one of the upper extremities
- Paraspinal muscles may go into spasm, causing discomfort on palpation
- Finger numbness and tingling
- Can cause spinal cord compression, where disc material pushes directly on spinal cord
CSP - CERVICAL HERNIATION - PROGNOSIS
- Over 95% of people with arm pain due to a herniated disc improve in about six weeks and return to normal activity. If you don’t respond to conservative treatment or your symptoms get worse, surgery may be recommended.
CSP - CERVICAL STENOSIS - DEFINITION
- A condition in which the spinal canal is too small for the spinal cord and nerve roots. This can cause damage to the spinal cord.
CSP - CERVICAL STENOSIS - CAUSES
- Bone spurs.
- Herniated discs.
- Thick ligaments - can become stiff and thick over time. Thick ligaments can push into the spinal canal.
- Tumors - Rarely, tumors can form inside the spinal canal.
- Spinal injuries
CSP - CERVICAL STENOSIS - AGE GROUPS AFFECTED
- Most people with spinal stenosis are over age 50
CSP - CERVICAL STENOSIS - RISK FACTORS
- Scoliosis or other spinal problems.
CSP - CERVICAL STENOSIS - CLINICAL PRESENTATION
- Numbness
- Tingling or weakness in a hand, leg, foot or arm
- Neck pain
- Common to present vague neurological symptoms -
- Problems with walking and balance
- Bowel and bladder inconsistence
- Pts expected to have hyperreflexia in the in their upper and lower extremities
CSP - CERVICAL STENOSIS - PROGNOSIS
- Spinal stenosis symptoms often become worse over time, but this may happen slowly. If the pain does not respond to these treatments, or you lose movement or feeling, you may need surgery.
CSP - CERVICAL FACET SYNDROME - DEFINITION
- A type of osteoarthritis that occurs when the structure of one or more of the vertebral facet joints begins to deteriorate
CSP - CERVICAL FACET SYNDROME - CAUSES
- Disk degeneration and disk narrowing increase facet joint loading and consequently facet osteoarthritis
CSP - CERVICAL FACET SYNDROME - AGE GROUPS AFFECTED
- 50 and above
CSP - CERVICAL FACET SYNDROME - RISK FACTORS
- Genetic disposition
- Smoking
- Either sedentary jobs at a computer or high levels of repeated muscle tension